Developing a Diabetes Numeracy Intervention for American Indians/Alaska Natives Project Summary Patients with diabetes must engage in a variety of self-care behaviors, including appropriate dietary practices, blood glucose self-monitoring, and medication management. Important to each of these behaviors is the capacity to understand and use numbers (e.g., counting carbohydrates). Referred to as numeracy, such abilities are associated with a variety of diabetes self-care behaviors and outcomes (e.g., glycemic control). Although the prevalence of diabetes has raised nationwide, American Indians and Alaska Natives (AI/ANs) are diagnosed with diabetes at 2-3 times the rate of non-Hispanic Whites. And, yet, Native people are at risk for limitations in the numerical skills that are criticl for diabetes management. Although deficits in numeracy are widespread, such limitations are particularly common among racial/ethnic minorities and individuals with limited income and education. As a result of restricted educational opportunities and high rates of poverty in many AI/AN communities, Native people with diabetes are at risk for limitations in diabetes-related numeracy. Despite evidence of a link between numeracy and health, no interventions aimed at improving health- related numeracy have been published. The goal of the proposed project is to develop and pilot test an intervention to improve diabetes-related numerical skills among AI/ANs with diabetes. The aims of the project are the following: (1) To develop a culturally appropriate intervention to teach the numerical skills required for successful diabetes self-management; (2) To assess change in numeracy skills following intervention; and (3) To explore change in diabetes self-efficacy, self-care behavior, and clinical outcomes following intervention and to assess whether change in numeracy predicts change in these secondary outcomes. The INTervention to Enhance Numeracy in Diabetes (INTEND) will be adapted from two existing numeracy curricula - Extending Mathematical Power (EMPower) and Statistics for Action (SfA) - which were developed to teach adults the math skills needed to manage everyday numerical tasks. The project team, which includes experts in AI/AN health and diabetes numeracy as well as the developers of EMPower and SfA, will adapt these curricula to address diabetes management among AI/ANs. The INTEND will be tested in a randomized controlled trial involving 130 AI/AN patients with diabetes from Yakama Indian Health Center in Toppenish, WA. Analyses will assess whether patients who participate in the INTEND show significantly greater improvement in numeracy, self-efficacy, self-care behavior, and clinical outcomes than do control patients. As no interventions designed to improve health-related numeracy have been reported in the literature, this innovative project will advance science related to numeracy and highlight a new avenue for intervening with AI/ANs and other populations at risk for diabetes and its complications. As similar numerical skills are required in the management of other serious health problems, such as cardiovascular disease and hypertension, the results of this work may inform the development of effective interventions for other conditions as well.